Intraoperative gamma detection probe with presurgical antibody imaging in colon cancer
J. A. Kuhn, R. M. Corbisiero, R. R. Buras, R. G. Carroll, L. D. Wagman, L. A. Wilson, D. Yamauchi, M. M. Smith, R. Kondo and J. D. Beatty
Department of Surgery, City of Hope National Medical Center, Duarte, Calif. 91010.
In this study, presurgical gamma camera imaging and an intraoperative gamma
detection probe were used in 12 consecutive patients 6 to 22 days after
infusion with indium 111-labeled anticarcinoembryonic antigen monoclonal
antibody (111In-MoAb). In three of 11 patients who underwent laparotomy,
clinical management was affected by the probe findings: localization of
occult retroperitoneal disease, identification of an occult cecal lesion,
and localization of residual disease at a site of local recurrence. Of all
intra-abdominal lesions seen using any method, the probe identified 18
(86%) of 21, compared with 14 (67%) of 21 with the 111In-MoAb scan, 10
(48%) of 21 by computed tomographic scan, and 16 (76%) of 21 after surgical
exploration. Uptake of 111In-MoAb in the portal (n = 3) and mediastinal (n
= 3) lymph nodes was not associated with histologic findings of malignant
neoplasms. For all pathologically confirmed extrahepatic and nonportal
sites of cancer, the probe localized nine of nine, compared with five of
nine by 111In-MoAb scan, two of nine by computed tomographic scan, and six
of nine by surgical exploration. Important clinical uses of the
intraoperative probe included occult lesion identification, localization of
areas with 111In uptake shown with MoAb scanning, and verification of
complete resection of areas with 111In-MoAb uptake.